3 Tips to Avoid Out-of-Pocket Costs With Fertility Insurance

Health insurance policies vary on how they handle coverage for fertility treatments. Your first step is to find out what your policy covers. Ultimately, it is your responsibility to know your insurance coverage, but there are places to turn for help.

If your insurance is through your work, check with your Human Resources department to speak with the person most knowledgeable about benefits. If you buy health insurance independently, ask your broker or insurance company. Most fertility clinics also have someone on staff who can help you understand your health insurance policy.

Once you understand your coverage, your second step is to avoid out-of-pocket costs in diagnoses and fertility treatment. Check out these 3 tips to help you along the way.

1. Consider in-network providers

Many health insurance policies only pay full benefits if you use providers that are within their network. Before you start incurring costs, whether with your OB/GYN or with your fertility specialist/reproductive endocrinologist (RE), confirm that the doctor you are seeing is within your network. If your doctor refers you or your partner to a specialist, first make sure that the specialist is within your insurance company’s network. Also specifically ask if all laboratories they use are in-network. This is especially the case if your fertility clinic uses an in-vitro fertilization (IVF) laboratory or genetic testing service that is not a part of its clinic.

2. Understand exactly what is covered

Even if your policy covers fertility, you must read the fine print to make sure that it covers the treatment and medication your doctor is prescribing. For example, your doctor might suggest that you genetically test the embryos prior to transfer to increase your odds of success. However, you may end up paying for genetic testing out of pocket, so it is a good idea to confirm first.

Another example is that your insurance may not cover all brands or types of medication. Before your treatment, let your clinic know what is covered and that you want your treatment to use the covered medication to avoid out-of- pocket costs.

3. Come up with a plan to avoid out-of-pocket costs

Money is a valid part of deciding on a treatment plan, and your doctor should be your partner in developing an approach that will maximize your insurance coverage while avoiding as many out-of-pocket costs as possible. The following are examples of the types of things you and your doctor should consider when developing a treatment plan.

  • IUI requirement. Some insurance policies require a specified number of intrauterine inseminations (IUIs) before other treatments will be covered. Even if your doctor believes that intravaginal culture (IVC) or IVF are your best choices for getting pregnant, your insurance may require a certain number of IUIs first before covering either.
  • IVF cycle limit or total dollar limit. Health insurance policies will often specify either a limit on the number of IVF cycles that will be covered or a dollar limit for all treatment. This is important information for your doctor and you to consider when creating a treatment plan to give you the best chance of a healthy baby and to avoid out-of-pocket costs.
  • Restrictions on coverage for some tests or procedures. Some insurance policies do not cover procedures such as intracytoplasmic sperm injection (ICSI) or assisted hatching. Knowing this in advance may alter the treatment plan.

Health insurance coverage for fertility treatments can be confusing, but with some planning, it is possible to maximize your coverage and avoid out-of-pocket costs on your way to having a baby.